학술논문
Detectable A Disintegrin and Metalloproteinase With Thrombospondin Motifs-1 in Serum Is Associated With Adverse Outcome in Pediatric Sepsis
Document Type
Academic Journal
Author
Boeddha, Navin P.; Driessen, Gertjan J.; Hagedoorn, Nienke N.; Kohlfuerst, Daniela S.; Hoggart, Clive J.; van Rijswijk, Angelique L.; Ekinci, Ebru; Priem, Debby; Schlapbach, Luregn J.; Herberg, Jethro A.; de Groot, Ronald; Anderson, Suzanne T.; Fink, Colin G.; Carrol, Enitan D.; van der Flier, Michiel; Martinón-Torres, Federico; Levin, Michael; Leebeek, Frank W.; Zenz, Werner; de Maat, Moniek P. M.; Hazelzet, Jan A.; Emonts, Marieke; Dik, Willem A.
Source
Critical Care Explorations. Nov 01, 2021 3(11):e0569-e0569
Subject
Language
English
ISSN
2639-8028
Abstract
IMPORTANCE:: A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 is hypothesized to play a role in the pathogenesis of invasive infection, but studies in sepsis are lacking. OBJECTIVES:: To study A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 protein level in pediatric sepsis and to study the association with outcome. DESIGN:: Data from two prospective cohort studies. SETTING AND PARTICIPANTS:: Cohort 1 is from a single-center study involving children admitted to PICU with meningococcal sepsis (samples obtained at three time points). Cohort 2 includes patients from a multicenter study involving children admitted to the hospital with invasive bacterial infections of differing etiologies (samples obtained within 48 hr after hospital admission). MAIN OUTCOMES AND MEASURES:: Primary outcome measure was mortality. Secondary outcome measures were PICU-free days at day 28 and hospital length of stay. RESULTS:: In cohort 1 (n = 59), nonsurvivors more frequently had A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels above the detection limit than survivors at admission to PICU (8/11 [73%] and 6/23 [26%], respectively; p = 0.02) and at t = 24 hours (2/3 [67%] and 3/37 [8%], respectively; p = 0.04). In cohort 2 (n = 240), A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels in patients within 48 hours after hospital admission were more frequently above the detection limit than in healthy controls (110/240 [46%] and 14/64 [22%], respectively; p = 0.001). Nonsurvivors more often had detectable A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 levels than survivors (16/21 [76%] and 94/219 [43%], respectively; p = 0.003), which was mostly attributable to patients with Neisseria meningitidis. CONCLUSIONS AND RELEVANCE:: In children with bacterial infection, detection of A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 within 48 hours after hospital admission is associated with death, particularly in meningococcal sepsis. Future studies should confirm the prognostic value of A Disintegrin and Metalloproteinase with Thrombospondin Motifs-1 and should study pathophysiologic mechanisms.